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Sleepless & Sweaty? Understanding the Link Between Menopause & Insomnia

Updated: 4 days ago

Exhausted menopausal woman experiencing insomnia

As I write this I’m currently a couple of months into a bout of insomnia, which is kind of ironic given that I recently attended a seminar led by Dr Guy Meadows, the clinical director of Sleep School.

The workshop offered a fascinating perspective on managing insomnia using Acceptance and Commitment Therapy (ACT), distinct to the traditional Cognitive Behavioural Therapy (CBT) approach that I was taught in my core training; but I had no idea at that point that I was about to be experiencing first hand the challenges that persistent insomnia can bring with it.

One of the first things that I learned was that whilst insomnia affects up to 20% of the world’s population, approximately 65% of sufferers are female.

This got me to thinking about why there could be such a disproportionate impact on women and wondering whether it could be attributable to the impact of (peri)menopause.


Understanding the Impact of Menopause on Sleep

A bedside table with sleeping pills and a digital clock to indicate disturbed sleep and insomnia in menopausal women

A little research informed me that sleep disruption is one of the main symptoms reported by women in this stage of life - difficulty falling and staying asleep, along with night sweats and hot flushes.

As we transition from perimenopause through menopause, to post-menopause the levels of our hormones oestrogen and progesterone start to fall off, which can have a huge impact on our sleep quality.

Oestrogen plays a crucial role in regulating sleep patterns but this hormone declines significantly during the transition to menopause, and this can disrupt our internal body clocks.

The low levels of Oestrogen can make it more difficult to drop off to sleep and more difficult to stay that way once we have finally managed it - frustrating!!

Oestrogen is also involved in regulating body temperature, which is one reason why when our levels start to drop off we can experience night sweats and hot flushes, the discomfort of which wakes us up in the early hours.

View of a menopausal woman's legs as she lies in bed experiencing restless leg syndrome

Progesterone is a hormone that promotes relaxation and sleep, so when the levels fall we can end up feeling restless (Restless Leg Syndrome is very common) and anxious – which is never conducive to restorative sleep.

It’s very easy for a vicious cycle to establish itself because night-time disturbances easily tumble through into day-time issues, such as poor concentration, irritability and fatigue.

Not only do these make managing the treadmill of life more challenging, but they can also exacerbate the day-time menopausal symptoms.

By bedtime, not only have we got to contend with the same hormonal influences as the previous night, but we may also carry with us baggage from our day-time experiences – feelings such as anxiety, frustration or despair about how things went, will also influence our likelihood of achieving a decent sleep. 

Rinse and Repeat…


Why Sleep Matters During Menopause

Sleep has an important biological function, not only does it give our bodies the opportunity for physical restoration (repair and growth) but it also gives our brains the opportunity to clear waste products that may have accumulated during wakefulness and to consolidate memories from the day.

So when these processes are being regularly disrupted it can start to cause problems for us.

A menopausal woman experiencing insomnia sitting on the floor next to her bed with her head in her hands

Chronically insufficient sleep can impact our ability to be attentive, concentrate on our task at hand, make sound decisions, and solve problems effectively; all of which can lead to us making more mistakes, being less productive and experiencing difficulties in learning new things.

There are additional issues connected with chronic sleep disruption.

It can lead to a weakening of the immune system, meaning that we may experience more frequent infections, illnesses and inflammatory conditions, and then have a longer recovery time than previously would have been normal for us.

The hormonal changes that occur due to menopause already put women at an increased risk of cardiovascular disease and metabolic disorders (e.g. type 2 diabetes), and chronic sleep disruption further contributes to the risk for the development of these conditions.

So managing sleep problems during this stage of life is crucial for reducing the risk associated with a number of very impactful long-term health problems.


Natural Strategies for Better Sleep

Don’t panic though, although it might feel scary to think about the problems that can be caused by disrupted sleep, there is a lot that we can do to help ourselves.

A menopausal woman lying in bed, peeking out from the covers to express fear and anxiety

Even if you don’t have children of your own you’re probably aware that getting babies and young children into a consistent sleep schedule is a “thing”.

There is a behavioural as well as a biological component to sleep and when we endeavour to establish a consistent sleep schedule what we’re effectively doing is programming the child’s brain to expect falling asleep as the ultimate step of the process. 

For some reason, we don’t seem to think about applying this to ourselves as adults, but it can work for us just as it works for children - by establishing a regular and consistent wind-down routine around bedtime we can help encourage the relaxed state that we require in order to be able to fall asleep. 

Our nervous system has two parts, the sympathetic and the parasympathetic. 

While the sympathetic pathway is responsible for carrying signals connected to being alert and is involved in our “fight or flight” response, the parasympathetic system carries signals for relaxation (including sleep). 

You can find a more detailed explanation of the sympathetic and parasympathetic pathways in a previous post, here.

From an evolutionary perspective, the sympathetic nervous system is what kept us safe, and was integral to the survival of our species; so it makes sense that this will override the sympathetic pathway - you probably wouldn’t have lasted very long if you could fall asleep in the middle of a wrestle with a sabre-toothed tiger. 

Of course, in the modern world, we’re not defending ourselves from large wild animals, but we can easily find our sympathetic nervous systems activated by the stresses and strains of daily life, along with the hormonal changes mentioned above. 

A menopausal woman tossing and turning in bed due to insomnia

So to develop an effective bedtime wind down we need to be thinking about how we can develop our ‘soothing system’ which facilitates the parasympathetic pathway. A more detailed explanation of the three emotional regulation systems, including the soothing system, is in my previous post, here.

It’s important to make sure that you feel comfortable and “safe” in the space where you sleep, so paying attention to your environment is important - is there anything that you can do to make it more comfortable for yourself to promote a sense of cosiness and safety? 

Of course, we’re all individuals and what is calming and soothing for one person

A cat cuddling up to a menopausal woman in bed to give her comfort as she experiences insomnia

might be quite annoying and irritating for others, so it might take a bit of experimenting to find things that you like in terms of your environment and what you like doing in terms of relaxation. 

Most importantly is making sure that whatever changes you make are sustainable and will fit into your life such that you can consistently do them as a routine.

Taking a hot bath or shower can help, because it takes advantage of the fact that when our body temperature drops it can make us feel sleepy - the hot water raises our temperature slightly so that when we exit the bath or shower we experience the drop, which in some people can encourage a sense of cosiness and sleepiness.

The timing of when we eat can also make a difference, and again it might take some experimenting - some people find that if they eat too late it interferes with sleep because they’re still digesting but then others find that if they eat too early they can’t sleep because they’re hungry; find your Goldilocks zone!

Daytime activity is relevant - I have certainly experienced times when I’ve felt very tired mentally but due to lack of physical activity during the day my body just doesn’t want to sleep. 

As with eating, the timing of the activity is important…I know that if I am very active shortly before bedtime I will struggle to drop off as I will still have too much adrenaline and cortisol floating about my system. 

For me, mornings are the best time for a tough gym session, but you may find your sweet spot is a bit later in the day.

A menopausal woman experiencing insomnia whilst watching tv in her bedroom

Light exposure is also an important factor to take into account when we’re considering sleep. 

Our circadian rhythm is significantly impacted by the light-dark cycle of day and night.

Photoreceptor cells in our eyes send signals to a part of our brain called the hypothalamus, which acts a bit like a control centre that interprets the light signals for our pituitary gland. 

This gland produces various hormones depending on the signals that it receives from the hypothalamus, so paying attention to the kinds of light, and when we’re exposed to them, can have a significant impact on what our hormones are doing.

Melatonin is a hormone associated with sleep and when we are exposed to daylight the signal comes through to the pituitary gland to suppress melatonin. It is also prompted to produce cortisol to make us more alert. 

At the other end of the day, the opposite process happens - darkness gives the signal for cortisol production to be dampened down and melatonin to be ramped up, which helps prepare to body to wind down and move towards a sleeping state. 

A calming sunset scene

Sunrises and sunsets aren’t just beautiful to watch, they will also help your body clock to synchronise with a day-night sleep cycle.

One of the problems with modern life is that we live in an environment of artificial lighting, and our faces spend many hours pointed at screens - this can confuse our body clocks because the photoreceptors in our eyes respond to the blue light emitted by the lighting and screens, so even if it is pitch black outside, our brain thinks it’s the middle of the day and not time to sleep.

Believe me, I know how difficult this is to try but see if you can have a screen-free hour before bed; you might find that it makes a difference…or you may not. 

As I keep mentioning, we’re all individuals, so I’m sure by now you’re getting the point that establishing a good routine for yourself that will meet your needs and fit in with the demands of your life is going to take a lot of trial and error.

There is no one single thing that is going to be the magic panacea - think of it more like making a patchwork quilt. 

A patchwork quilt depicting a metaphor for insomnia solutions during menopause

An individual square isn’t much in and of itself, but once all the squares are sewn together you have something that will keep you warm and looks beautiful to boot. 

So play around, tweaking and changing different things, learning what helps and what doesn’t, until you see some improvements.

Medical Interventions and Therapies

If after trying self-help strategies you are still struggling, then it is worth speaking with your GP. 

In addition to exploring HRT angle for the physical menopause-related symptoms, there are additional options that you can look at such as dietary supplementation (for example, certain forms of Magnesium supplement are known to aid sleep quality) and, coming full circle to the start of this blog post, Cognitive Behavioural Therapy (CBT-I) or Acceptance and Commitment Therapy (ACT-I) for Insomnia which can help you with managing any anxiety or stress relating to the lack of sleep that can sometimes arise.

Subscribers to my blog can take advantage of a 40% discount on the Sleep School app created by Dr Meadows. If you didn't receive your email with details of the offer then please get in touch and let me know!

Concluding Thoughts on Menopause and Insomnia

The key message here is that it’s crucial to remember that although each journey through this stage of life is as unique as the individual experiencing it, there are likely plenty of people around you who can relate to you and your experiences.

Two menopausal women sharing a coffee and talking about their experiences of insomnia

Don’t suffer in silence - talk to your friends and share what you are going through.

Exchange ideas about what’s worked for you and what hasn’t…the more we share the more we can learn. 

When we embrace the changes that we are going through with a proactive mindset, it can help us to feel empowered to climb into the driving seat and learn how to navigate the challenges of sleep disturbances in the best way we can - to live the best version of our lives despite our sleep challenges. 

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